Diagnosis and severity of asthma in the elderly: results of a large survey in 1,485 asthmatics recruited by lung specialists.

Background: Despite its high prevalence, epidemiological surveys on the diagnosis and severity of asthma in the elderly are seldom.

Objective: The objectives of our study were: (i) to describe the criteria, used by French lung physicians, for the diagnosis of asthma in the elderly (age > or = 65 years); (2) to investigate whether the age at the onset of asthma is related to the severity of asthma in the elderly.

Methods: 1,485 asthmatics (783 men and 702 women; mean age +/- SD = 73.2 +/- 6.0 years) were included in this descriptive survey. They were recruited by 379 lung specialists who filled in standardized questionnaire.

Results: 56% of men and 10% of women (p < 0.001) were smokers or ex-smokers FEV(1)/VC was significantly lower in men than in women (60.6 +/- 16.1 versus 66.1 +/- 16.9%; p < 0.001). Diagnostic criteria of asthma were both clinical and functional in 89% of cases. Bronchospasm reversibility was tested with inhaled beta(2)-agonists (89%) and/or oral corticotherapy (36%). Asthma had been diagnosed before the age of 20 years in 10.4% of the patients, between 20 and 50 years in 28.3%, between 51 and 65 years in 38.1%, and after the age of 65 years in 23.2%. Higher FEV(1) % of theoretical values and higher FEV(1)/VC were observed in subjects with late-onset asthma. The mean of FEV(1) % of theoretical values was 58.1 +/- 19.5% in subjects with asthma diagnosis before the age of 20 years, 60.5 +/- 20.4% in those with asthma diagnosis between the age of 20 and 50 years, 62.5 +/- 19.4% in those with asthma diagnosis between the age of 50 and 65 years, and 67.1 +/- 21.4% in those with asthma diagnosis after the age of 65 years (p < 0.001). The mean number of drugs taken was significantly lower (2.2 +/- 0.4) in late-onset asthma than in early-onset asthma (2.8 +/- 0.1; p < 0.001).

Conclusions: This study suggests that the severity of asthma may depend on age at the onset of symptoms and diagnosis. Early diagnosis and treatment may prevent the adverse consequences of persistent asthma.